Ala. city struggles to enforce ambulance code

The sole ambulance provider in Decatur is failing to meet mandatory response times set forth in the city code


By Eric Fleischauer
The Decatur Daily 

DECATUR, Ala. — The sole ambulance provider in Decatur is failing to meet mandatory response times set forth in the city code, but before the City Council can enforce the code it must receive a recommendation from a committee that hasn’t met since November because it can’t muster a quorum.

“Until the EMS Committee gets together and has the gumption to recommend enforcement, it’s not going to make it to the council,” said Assistant City Attorney Chip Alexander. “That’s one of the big problems with the ordinance.”

First Response ambulance is the only provider that has been granted a permit to operate in Decatur’s city limits and police jurisdiction. The city’s ambulance ordinance requires it to respond to 90 percent of calls within city limits in eight minutes or less. It’s required to respond to 90 percent of calls in the police jurisdiction in 12 minutes or less. The times are tracked by Morgan County 911 and compiled by the Fire Department.

In April, First Response met the eight-minute response time on 89.2 percent of in-city Category 1 calls, the most serious. Out of 353 Category 1 calls that month, ambulances exceeded the eight-minute mark 38 times. Category 1 calls involve conditions posing an immediate threat to life.

First Response met the eight-minute mark on 91.8 percent of in-city Category 2 calls, which involve a serious condition that may require rapid assessment or urgent transport. Its in-city response times to Category 1 and 2 calls combined were 90 percent.

In the police jurisdiction in April, First Response met the 12-minute requirement on 90 percent of its 20 Category 1 calls, but only 72.7 percent of its 11 Category 2 calls.

In the fourth quarter of 2017, First Response also failed to meet the ordinance’s requirements. Eighty-eight percent of in-city Category 1 and 2 calls met the eight-minute mark and 85 percent met the 12-minute PJ requirement.

The ambulance ordinance details an elaborate and time-consuming enforcement procedure when an ambulance provider fails to meet required response times or numerous other requirements. Only the City Council can enforce the ordinance against First Response, and it can’t do so without committee input.

“The way I read the ordinance is that it does not get to the council without a recommendation from the EMS Committee,” Alexander said.

EMS Coordinator Janice Johnson, a battalion chief at Decatur Fire and Rescue, said it’s always a struggle to get a quorum of the EMS Committee. A meeting scheduled last week had to be canceled.

“Trying to get everybody together is a hassle,” Johnson said. “That’s the holdup at the moment.”

Part of the problem is that the ordinance specifies the emergency department directors of both Parkway Medical Center and Decatur General Hospital are to be members. Since the acquisition of both hospitals by the Huntsville Hospital System, however, a single person holds that position for both hospitals. Thus there are only seven possible members of the committee, but five are still needed to constitute a quorum as defined by the ordinance.

Further complicating efforts to get a quorum is that one member is to be appointed by the mayor. Dr. Dale Trammell held that spot for more than two decades, but he has left the committee. Mayor Tab Bowling has not appointed a replacement.

“We asked (Bowling) to do that months and months ago,” said Council President Paige Bibbee. “We requested that the mayor find a new replacement for his appointment. That’s the last I heard about it. I can’t demand it; I can only ask it. I don’t know what else we can do.”

Because Trammell has not been replaced, there are only six possible members of the EMS Committee, five of whom must show up for a quorum.

Bowling said he does not plan to appoint a replacement until an ongoing effort to draft a new ambulance ordinance is complete.

“Making an appointment right now, not knowing where that will end up, I don’t think would be a wise decision,” he said. “I’m just kind of waiting to see where the council lands on the path forward before we do anything.”

Alexander is coordinating the preparation of the new ordinance, which he plans to present to the council June 25. Even if the council proposes no changes, it could be months before the ordinance is formally adopted and its planned mechanism for accepting bids from competing ambulance services is implemented.

“It’s going to take awhile,” said Bibbee. “My hope is before the end of the year we’ll have all this settled. But I move fast and I know government doesn’t, which is one thing that drives me crazy.”

Efforts to get a five-person quorum from an unpaid six-member committee are also difficult because the members are balancing other duties. Two of the designated members — the hospital emergency department director and the medical director for Decatur Fire and Rescue — are doctors employed elsewhere. The city’s police and fire chiefs are members, as are the directors of Morgan County 911 and the Morgan County Emergency Management Agency.

Bibbee said she’s not worried about the EMS Committee’s difficulty in getting a quorum because it has no authority and because the City Council could “absolutely” take action without it.

“The EMS committee has no power,” she said. “If anything is brought to them they make a recommendation to the council, but they have no powers. They’re just there — or should be there — as a tool to help make the right decision. Now this board hasn’t done that for years, if it ever did.”

The assistant city attorney, however, explains that the existing ordinance prevents the council from taking action against First Response without first receiving a recommendation from the committee.

The minutes of the EMS Committee's November meeting indicate members quizzed David Childers, president of First Response, about deficient response times.

“What is the problem then as you are still under 90 percent and have been for over a year?” asked Dr. Tomeka Archinard, who was then head of Decatur Morgan Hospital’s emergency room, according to the minutes.

Childers responded, “We have zero control over our service,” the minutes reflect.

He went on to say the hospital is slow to process patients, which ties up First Response ambulances and personnel. He also said his ambulances are sometimes called on to assist other ambulance providers in the county, and that Morgan County 911 needs to do a better job dispatching calls.

“Your company has been out of compliance for a long time,” committee Chairman Ricaurte Solis said, according to the minutes. “I want to know what you are doing about it. Don’t keep blaming everyone else.”

Bowling last week also expressed concerns with response times.

“They didn’t during the (November) meeting show any indication as far as a plan to overcome that,” he said. “They spent most of their time, the record showed, defending why those numbers were recorded.”

Childers last month said his company is doing well.

“I think First Response is the best EMS provider the city of Decatur has ever had,” he said. “We’re not a company from out of state that is a franchised company. We want to take care of the people that we have to see at Walmart every day. We want to be the best we can, and we’ve brought a whole different level of EMS to the city of Decatur since 2012 when we started.”

Copyright 2018 The Decatur Daily 

McClatchy-Tribune News Service

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